Abby Ilyce Gordon, D.P.T., EMT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

60495067 Issued in WA

Practice address

17901 Bothell Everett Hwy Ste F-104
Bothell, WA 98012-6387

Phone

(425) 424-3924

Fax

(425) 424-3941

NPI assigned

Aug 25, 2014

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Emergency Medical Technician

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Therapeutic Associates Inc

  dba TAI Cedar Hills Physical Therapy

  • Physical Therapist
  • Portland, OR
  • NPI 1700862000
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1720488950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD STE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "800-219-8835",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17901 BOTHELL EVERETT HWY STE F-104",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980126387",
            "telephone_number": "425-424-3924",
            "fax_number": "425-424-3941"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3225 NE 125th St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981254516",
            "country_code": "US",
            "telephone_number": "206-417-1298",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3225 NE 125th St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981254516",
            "country_code": "US",
            "telephone_number": "206-417-1298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "ABBY",
        "middle_name": "ILYCE",
        "credential": "D.P.T., EMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-25",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "CT",
            "license": "17180",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "10234",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "60495067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2064003",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bernadeth Tagle Gonzales, MD
• Christopher Jorge Gonzales, PT
• Sherri Jo Gooch, PHARMACY TECHNICIAN
• Christopher Robin Goodman, OT
• Erian Goodson, LMT
• Edmond Gordon, DPT
• Ronit Gourarie, RN
• Wenona Grados
• Donald Graff, PTA
• Katherine Graff, RN

• Physical Therapist in Bothell, WA
• Providers in Bothell, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.